Chapter Text
Crowley sat at the nurse's station, sipping his fourth cup of coffee for the evening. A&E had been busy for most of his shift but had finally started to slow down. This was normal as the time approached four in the morning. "Doctor Crowley, can you sign these discharge papers for me?" Nurse Michael said as he tossed a couple of files into Crowley's view.
Sighing, Crowley looked up. "I was just about to go on break, who are they for?"
"Just the frequent flyers," Michael said.
"Have the nurse practitioner do it," Crowley said and pushed himself to his feet. "Tell them I said they're alright to do it. I'm assuming there's nothing concerning any of these patients to keep them here?"
"That is correct, Doctor Crowley," Michael said.
"Eh, either way, have the nurse practitioner check them out before she signs off on them." Michael nodded and picked up the files to go find nurse Anathema.
Crowley headed for the break room, to see if there was anything good he could steal from the head nurse Hastur's lunch. Hastur had always been cranky and borderline unprofessional. Crowley wondered if that's why he got put into the office upstairs. Although Crowley wouldn't trust him with trying to solve ethical matters either.
Just as he was about to open the door to the break room, nursing supervisor Beverly came around the corner. "There you are," she said and Crowley inwardly groaned. "EMTs called, they're about fifteen minutes out with a trauma. Auto accident, 32 year old male, critical condition. Do you want us to divert them?"
Crowley did sigh this time. "No," he said. "Did they give you any more details? Vitals? Location or extent of injuries?"
"They said they would send that in the next couple of minutes," Beverly replied. "They wanted to know if we could take him."
"Tell them yes, and have them send that other information right away," Crowley said. "I'd like to know what I'm dealing with before they arrive."
"Of course," Beverly said and hurried off.
Crowley entered the break room and grabbed a bottle of water from the fridge. He knew he didn't have time to eat anything so he quickly drank down the water and returned to the nurse's station.
"Did the EMTs send in the vitals for the incoming trauma yet?" Crowley asked Beverly when he noticed she had her nose stuck in a file.
"Yes," she replied and handed over the paper she was currently reading through.
Crowley took it and started reading: pulse and blood pressure were low. Patient suffered lacerations and blunt force trauma to the face, possible whiplash to the neck, notable thoracic injuries, fracture of the right femur...this was likely the driver of the vehicle, Crowley noted. "Uh let's get a cardiovascular consult," he said to Beverly. "I'm not a specialist in emergency medicine, but injuries to the chest are never a good thing. And while you're at it, get ortho as well. He's got a fractured femur and likely a few ribs."
"Yes, Doctor Crowley," she said and picked up the phone to get the on-call physicians out of bed.
As he waited, Crowley carefully repeated the steps for assessing trauma patients in his head. It had been a good while since he had treated someone in critical condition. He would take a few shifts every couple of months to help out the hospital when A&E were short staffed.
Usually at least two physicians would work A&E, one that was specifically trained in emergency medicine and trauma, and the other to take on the less sick or injured patients. As just a general practitioner, Crowley preferred to take on the role of the latter. But tonight he had been forced to take on both roles as the other attending physician had called out. He was lucky enough that he had a nurse practitioner on with him tonight.
"Five minutes out," Beverly said. "Ortho and cardio are on their way. But they may take a little bit of time to get here."
"Right," Crowley said. He wasn't surprised. "Let's get some O neg up here and a portable chest x-ray." He shrugged out of his lab coat and dropped it across the back of his chair, before rolling up the sleeves on his black dress shirt.
When the ambulance arrived, Crowley was surprised to see that his patient was conscious. Considering that he was in respiratory distress and flailing around, or at least trying to. The EMTs had strapped him to the bed. "Was he like this when you picked him up?" Crowley asked.
"Yes," the Paramedic replied.
"Did you give him anything?"
"No, Doctor Crowley," he said. "We didn't want to risk respiratory arrest."
Crowley nodded and went to work. "Let's get that chest x-ray and start him on saline while we wait for the O neg."
"Any morphine, Doctor Crowley?" Michael asked as he prepared the intravenous saline.
"Not yet," Crowley said. "I need to assess his airways first." He started by visually inspecting and palpating his patient's trachea and down to his chest. He listened with his stethoscope for breath sounds and palpated to check for tenderness and any damage to bones or cartilage. He did have a few and his O2 stats were low. Low enough that Crowley knew he had to do something about it.
"His O2 saturation is at 83%, Doctor," Beverly said.
"I'm aware of that," Crowley said. "Get an intubation kit." He looked at Michael. "Let's give our patient Propofol and Succinylcholine so that he doesn't feel me putting a tube down his throat, yes?"
"Yes, Doctor." Michael prepared the proper doses and administered them to the patient.
Once his patient was unconscious and Beverly had returned with the intubation kit, Crowley took a deep breath and tried not to inwardly panic. He could do this. He'd done it before, not in many years. But he had…
Tilting the patient's head back, he used the light to look down past the vocal cords until he was fairly confident that he would be able to correctly place the tube. Crowley quickly grabbed it and put it in place, praying that he would have good breath sounds once he'd finished.
"I have the blood," Beverly said.
"Good, let's start with one unit and monitor his blood pressure," Crowley said as he prepared to check for breath sounds. To his relief, they sounded okay. His patient's saturation levels had improved slightly. "Do we have the chest x-ray?"
"Radiology is on their way," Beverly replied.
"Let's order a CT scan as well," Crowley said, inspecting the swollen lacerations on his patient's face. "Make sure he doesn't have a brain injury."
"Yes, Doctor."
Crowley stood there for a moment, staring at the monitors. Pulse was still bradycardic, BP was stable but not high enough for Crowley's liking, much the same with his oxygen saturation level. He sighed. "Does this poor bloke have any family?"
"EMTs left his personal items with the front desk receptionist," Michael said. "I'm assuming Tracey called whoever his family is."
Crowley nodded. A few minutes later, the technician from radiology showed up to do the chest x-ray. Once they had finished and Crowley had the film, he took a look at it. "Several broken ribs…" he sighed. "Looks like some heart damage as well." He grabbed the film and handed it to Beverly. "Show this to Newt when he comes in, I'm not sure of the extent of the heart damage. I'll write down everything I did in the file and then pass him along to Ortho and cardio. They can determine the next course of treatment. I've stabilized him as best I can. I just hope the poor fellow doesn't have any significant brain injuries."
"Should I call for a neuro consultation?" Michael asked.
"No," Crowley replied. "Let's wait until we receive the results of the CT. He has head injuries but it was his chest injuries that were of concern."
"Of course."
Crowley sighed and plopped himself down in a chair to start writing in the file. He had just finished when Doctor Newton Pulisfer came up to him. "I hear you have a patient for me, Crowley?"
Crowley nodded. "Room one," he said. "Male, 32 years old, auto accident. Was in critical condition when he came in. I was able to get him up to serious condition. His vitals are stable but not good. He's out for a CT scan at the moment. Unconscious and intubated. The chest x-ray is of concern." He closed the file and handed it to Newt. "I've done everything I can for him, so I'd like to know if I can transfer his care to you, as his attending physician. I'm sure Uriel won't mind when she gets here. Her concern is with his femur and ribs. Beverly has the x-ray."
"Not at all, thank you, Crowley." Crowley gave him a nod before Newt headed off to the trauma room to look at the x-ray.
Crowley sighed and looked at the clock. Maybe he could actually get a break before Doctor Jones came in for her shift. Crowley still needed to stay and finish out his twelve hours but at least he would have another attending physician working with him.
“Going on a real break now,” Crowley said to Beverly as she sat down next to him and pulled up the patient admission chart on her computer. “Gotta see what Hastur has in his lunch that’s tasty.” Beverly snorted and Crowley grinned. He knew that Hastur never really had anything exciting in the fridge, but it was nice to think about.